Community Power
in Population
Health Improvement
PROCEEDINGS OF A WORKSHOP
Anna Nicholson and Tamara Haag, Rapporteurs
Roundtable on Population Health Improvement
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and AAMC, Aetna Foundation, BlueCross BlueShield of North Carolina, Nemours, The Rippel Foundation, Robert Wood Johnson Foundation, The University of Texas at Austin, and Wake Forest Baptist Health/Stakeholder Health. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-09349-1
International Standard Book Number-10: 0-309-09349-X
Digital Object Identifier: https://doi.org/10.17226/26306
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Community power in population health improvement: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26306.
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PLANNING COMMITTEE ON COMMUNITY POWER IN POPULATION HEALTH IMPROVEMENT1
HANH CAO YU (Chair), Chief Learning Officer, The California Endowment, Oakland, CA
GARY R. GUNDERSON, Vice President, Faith Health, School of Divinity, Wake Forest University, Winston-Salem, NC
LOURDES J. RODRÍGUEZ, Senior Program Officer, St. David’s Foundation, Austin, TX
ARVIND SINGHAL, Professor of Communication and Director of the Social Justice Initiative, The University of Texas at El Paso, El Paso, TX
ADITI VAIDYA, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1
SANNE MAGNAN (Co-Chair through December 2020), Senior Fellow, HealthPartners Institute, Emerald Isle, NC
JOSHUA M. SHARFSTEIN (Co-Chair through December 2020), Vice Dean for Public Health Practice and Community Engagement, Professor of the Practice, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
RAYMOND BAXTER (Co-Chair from January 2021), Trustee, Blue Shield of California Foundation, San Francisco, CA
KIRSTEN BIBBINS-DOMINGO (Co-Chair from January 2021), Professor and Chair of the Department of Epidemiology and Biostatistics; Lee Goldman, MD, Endowed Professor of Medicine; Vice Dean for Population Health and Health Equity, University of California, San Francisco, School of Medicine; San Francisco, CA
PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC
DAWN ALLEY, Chief Strategy Officer, Center for Medicare & Medicaid Innovation, Washington, DC
JOHN AUERBACH, Executive Director, Trust for America’s Health, Washington, DC
CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance (MIHIA); Consultant for Health Strategy, The Dow Chemical Company, MIHIA, Saginaw, MI
DEBBIE I. CHANG, President and Chief Executive Officer, Blue Shield of California Foundation, San Francisco, CA
ALLISON GERTEL-ROSENBERG, Operational Vice President, National Policy and Practice Nemours, Washington, DC
MARC N. GOUREVITCH, Professor and Chair, Department of Population Health, New York University Grossman School of Medicine, New York, NY
GARTH GRAHAM, President, Aetna Foundation, Hartford, CT
MARGARET GUERIN-CALVERT, Senior Managing Director and President, Center for Healthcare, Economics and Policy, FTI Consulting, Washington, DC
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
GARY R. GUNDERSON, Vice President, Faith Health, School of Divinity, Wake Forest University, Winston-Salem, NC
DORA HUGHES, Associate Research Professor of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
SHERI JOHNSON, Director, Population Health Institute; Acting Director, Robert Wood Johnson Foundation Culture of Health Prize; Associate Professor, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI
WAYNE JONAS, Executive Director, Integrative Health Programs, H&S Ventures, Samueli Foundation, Alexandria, VA
ROBERT M. KAPLAN, Professor, Center for Advanced Study in the Behavioral Sciences, Stanford University, Stanford, CA
MICHELLE LARKIN, Associate Vice President and Associate Chief of Staff, Robert Wood Johnson Foundation, Princeton, NJ
MILTON LITTLE, President, United Way of Greater Atlanta, Atlanta, GA
PHYLLIS D. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation, Troy, MI
BOBBY MILSTEIN, Director, ReThink Health, Morristown, NJ
JOSÉ T. MONTERO, Director, Center for State, Tribal, Local and Territorial Support; Deputy Director, Centers for Disease Control and Prevention, Atlanta, GA
VON NGUYEN, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of North Carolina, Durham, NC
WILLIE OGLESBY, Interim Dean, College of Population Health, Jefferson University, Philadelphia, PA
JASON PURNELL, Vice President, Community Health Improvement, BJC HealthCare; Associate Professor, Brown School, Washington University in St. Louis, St. Louis, MO
LOURDES J. RODRÍGUEZ, Senior Program Officer, St. David’s Foundation, Austin, TX
PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ
KOSALI SIMON, Herman B. Wells Endowed Professor, Associate Vice Provost for Health Sciences, Paul H. O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN
HANH CAO YU, Chief Learning Officer, The California Endowment, Oakland, CA
Health and Medicine Division Staff
ALINA BACIU, Roundtable Director
CARLA ALVARADO, Program Officer (through January 2021)
AYSHIA COLETRANE, Senior Program Assistant
HARIKA DYER, Research Assistant
ROSE M. MARTINEZ, Senior Director, Board on Population Health and Public Health Practice
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
JASON PURNELL, BJC Healthcare; Washington University in St. Louis
IRENE YEN, University of California, Merced
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRUCE N. CALONGE, The Colorado Trust. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
We also thank staff member ANA FERRERAS for reading and providing helpful comments on this manuscript.
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Contents
Organization of the Proceedings
National Domestic Workers Alliance
A Theory of Power to Achieve Change
3 COMMUNITY POWER IN THE CONTEXT OF POPULATION HEALTH
Addressing Power Dynamics in Health
Personal Experiences in Power Building
Addressing Internalized Devaluation
Institutionalizing Power Building
Objectivity and Relational Work
Equality Improvement Conditions
4 COMMUNITY POWER: APPROACHES AND MODELS
Healthy Richmond Collective-Building Policy Initiative
The Positive Deviance Approach
5 FROM VISION TO ACTION: EFFECTIVE WAYS TO SUPPORT GRASSROOTS COMMUNITY POWER BUILDING
Community Power-Building Ecosystem
Partnerships Between Researchers and Community Groups
Current Power-Building Strategies and Approaches
6 COMMUNITY-LED TRANSFORMATIONAL NARRATIVES
Go Austin/Vamos Austin Community Initiatives
Church-Based Community Services
Policy Advocacy for Health Equity
Community-Centered Revitalization
7 AMPLIFYING THE EMPIRICAL BASE LINKING COMMUNITY POWER AND HEALTH EQUITY
Personal Drive for Power Building
Challenges and Tensions in the Exercise of Community Power: Practice Implications for Research
The California Endowment: Building Healthy Communities
Building Evidence for Power and Health: The BHC Initiative as a Learning Engine
Community Power and Health Equity: The Memphis Model’s Cardiac Disparity Case Study
B Biosketches of Speakers, Moderators, and Planning Committee Members
Boxes, Figures, and Table
BOXES
1-3 Definitions of Power Provided by Speakers
2-1 Recognizing Oppression Within Oneself
4-1 Healthy Richmond’s Vision, Purpose, and Horizon Statements
5-1 Robert Wood Johnson Foundation’s Definition of Community Power
FIGURES
2-1 The theory of power used by NDWA
5-1 Domains of power in health, equity, and justice
5-2 Approaches to cultural, political, economic, and transformative power building
Acronyms and Abbreviations
AMI | acute myocardial infarction |
BHC | Building Healthy Communities |
BHCLB | Building Healthy Communities Long Beach |
BVM | Black Voters Matter |
CARE | community, advocacy, resilience, and evidence |
CAUSE | Central Coast Alliance United for a Sustainable Economy |
CBPR | community-based participatory research |
CHN | Congregational Health Network |
COVID-19 | coronavirus disease 2019 |
GAVA | Go Austin/Vamos Austin |
HIP | Human Impact Partners |
ICSF | Iglesia Cristiana Sin Fronteras |
JHU | Johns Hopkins University |
LBF | Long Beach Forward |
LGBTQ | lesbian, gay, bisexual, transexual, queer |
MLH | Methodist Le Bonheur Healthcare |
MSC | Movement Strategy Center |
NDWA | National Domestic Workers Alliance |
P3 | possible, powerful, and probable |
PICO | People Improving Communities through Organizing |
RFF | Rockefeller Family Fund |
RWJF | Robert Wood Johnson Foundation |
SNF | Stavros Niarchos Foundation |
TCE | The California Endowment |
USC | University of Southern California |
USC PERE | University of Southern California Program for Environmental and Regional Equity |
UTEP | The University of Texas at El Paso |
WFBH | Wake Forest Baptist Health |